Healthcare Provider Details

I. General information

NPI: 1689652265
Provider Name (Legal Business Name): JESSICA S FRIEDMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY SUITE 220
EUGENE OR
97401-8176
US

IV. Provider business mailing address

1755 COBURG RD UNIT 503
EUGENE OR
97401-4900
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-7007
  • Fax: 541-726-5028
Mailing address:
  • Phone: 541-505-7510
  • Fax: 541-654-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD20982
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD20982
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier151171
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: